Question 1. What is the Current Landscape of Medical Student
Interpretation?
1.1 Medical students are frequently asked to interpret in
the clinical setting. During the clerkship phase of training, medical
students become active members of the healthcare treating team and
interact closely with patients. The literature shows that bilingual
medical trainees frequently act as interpreters for patients with
limited language proficiency and with whom they share a common language.
This was found to be especially true in the United States, where most
bilingual (English- and Spanish-speaking) students in a single
graduating class (84%) reported being asked to interpret at some point
during their clinical rotations (Table 1 ).32A similar trend has been found for other languages by Vargas Palaez et
al, who surveyed fully bilingual first to third year medical students
(speaking 21 languages) in Pennsylvania and reported that 55% of them
had interpreted in community/healthcare organizations, and 79% had
interpreted for family/friends.21 Similar data was
reported in New Zealand and in Australia, where 50% and 34% of
bilingual students respectively reported having acted as ad-hoc
interpreters during their clinical training.25, 33 In
most instances, students were involved for brief information relaying or
interpretation of patients’ conditions and treatments. However, several
studies have also reported student involvement during complex
procedures, critical care situations, and emotionally sensitive clinical
encounters.25, 33, 34 It is also worth mentioning that
the majority of medical students (>95%) surveyed in the
above studies had no formal interpreting training or qualifications.
1.2 Training programs in medical interpretation have been
developed for medical students. This review identified five medical
interpretation training programs developed for medical
trainees.15, 21, 34-36 The existing training programs
vary in structure, duration, content, and assessment/evaluation.
Information on these five training programs has been summarized inTable 2. All programs include theoretical foundation on the
ethics of interpretation, as well as practical sessions where students
participate in role-play activities or sample clinical scenarios. In
terms of evaluation and assessment for official certification, these
programs include either formal assessment via an examination, or direct
observation during an interpretation session. These methods can be
compared to current competency-based evaluations in medical curricula.
Assessments and observations are performed by professional interpreters
or bilingual physicians 15, 35, 36Moreover, additional
certification in medical interpretation upon completion of the standard
training is offered as an option to pursue by two of the programs.15, 21 None of the studies measured transfer of
learning, which is defined as one’s capacity to apply learned skills in
a new setting.37 Finally, all training programs are
optional for medical students.
The effectiveness of the above training programs has been demonstrated
through student self-assessments and/or feedback from healthcare teams
and patients. Upon completion of training, most students reported an
improvement in interpreting comfort, understanding of the interpreter’s
role, interpretation skills, and empathy towards LLP
patients.21, 34, 36 In two of the studies, student
trainees were rated highly by hospital staff, professional interpreters,
and patients. 34, 35
1.3 Limitations of medical interpretation training
programs. Several limitations have been identified for the training
programs. Vargas et al has pointed that medical students often find it
difficult to participate in prolonged training programs due to their
busy schedules. It was suggested that programs should be modified to
reduce time commitment. 21 The lack of objective
comparison with control group of untrained students has also been
identified as a major challenge when assessing training effectiveness.21, 34 Moreover, though most programs collected
self-assessments from participants, many lacked objective third-party
assessment. 21, 34, 36